A reappraisal of primary gallbladder carcinoma

A 10‐year experience with 14 patients with primary carcinoma of the gallbladder encountered in a typical community hospital has been reviewed. Abdominal discomfort in its many manifestations occurred in all patients, with chronic pain of long duration frequently being noted. Six patients were jaundiced. Twelve had documented cholelithiasis. Histologic examination revealed adenocarcinoma in all instances. One patient is alive and well at 3 years; survival of the remaining patients was from 9 days to 25 months. Primary carcinoma of the gallbladder occurs in more than 1% of surgically removed gallbladders. The disease is largely one of elderly persons with chronic calculous cholecystitis. Not only will it be seen with increasing frequency as life expectancy increases, but also it is preventable. Improvement in treatment can thus be initiated by prophylactic removal of diseased gallbladders in otherwise healthy persons. Malignancy may be obscured in those patients presenting with acute cholecystitis eluding surgeon and pathologist alike. These cases, as well as all early malignancies, are diagnosed only by careful histologic examination. Therefore, all gallbladders should be opened and examined by the surgeon in the operating room. Suspicious areas should be evaluated histologically by frozen section so that extension of the operation to include removal of adjacent hepatic parenchyma and performance of an extensive regional lymphadenectomy can be undertaken if cancer is found. By routinely considering every older patient who comes to cholecystectomy as suspect of harboring gallbladder cancer, survival may well be improved.